https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/07/21/le-demantelement-du-racisme
Difficult and uncomfortable conversations can no longer be avoided
By Yvonne Sam
July 21, 2025
envato.com/wavebreakmedia
The persistent bias and discrimination that Black nurses and patients face in health-care settings are not isolated issues; they are systemic barriers that compromise the very core of nursing’s mission to provide quality care to all.
“In a racist society, it is not enough to be non-racist; we must be anti-racist.” — Angela Y. Davis.
The time has come for all Canadians to acknowledge that anti-Black racism is omnipresent in Canada. The belief that there is little to no racism in Canada in itself serves as a barrier to truly addressing the issue.
While the country claims pride in its role in the Underground Railroad — memorializing our function as a haven for freedom‐seeking Americans fleeing to the north — we also have our own long history of slavery, the legacy of which lives on in anti‐Black racism present in Canada today (McCullough & McRae, 2018).
According to Jefferies (2020), anti-Black racism is defined as the specific processes, decisions, and policies that intentionally or unintentionally discriminate against Black people. The dismantling of anti-Black racism in nursing is not simply a moral duty, but rather a moral imperative, and we cannot afford to turn a blind eye to the ways in which it is incorporated into the very fabric of our institutions.
As Canadians, we must be prepared to confront our fears, examine our biases, challenge discriminatory practices, and work together to dismantle anti-Black racism in nursing, not only to ensure better practices and treatment, but also to uphold the integrity of the profession. No longer can difficult and uncomfortable conversations be avoided. We must explore anti-Black racism to fully understand the pervasive nature of racism and the need to identify and dismantle it in all its forms (Canadian Human Rights Commission, 2021).
The historical impact of racism on nursing
The historical impact of racism has been far-reaching, and still continues to influence the profession today. Understanding this history is crucial in the dismantling of racism in nursing education and health-care delivery.
The following are ways in which historical racism has shaped nursing:
Exclusion of nurses
In the early history of nursing in Canada, Black nurses were systematically excluded from formal nursing education and professional organizations, and denied the opportunities to become registered nurses or hold leadership positions.
The first nursing school in Canada opened in 1874, with the first baccalaureate program offered in 1919. Not until the late 1940s were Black women permitted to train as nurses. At the time, Black women who aspired to be nurses were instead instructed to travel and train in the United States (McPherson, 2003).
Historical inconspicuousness of Black nurses
Black nurses who have made noteworthy contributions to the profession have been erased from historical narratives. The contributions of early Black Canadian nurse trailblazers, such as Bernice Redmon, Ruth Bailey, and Gwen Barton, are omitted in nursing education (Flynn, 2011; Jefferies, 2020). Further evidence shows that this legacy of discrimination and exclusion of Blacks has contributed to the residual anti-Black racism practices that remain in Canadian nursing (Jefferies, 2020).
Gaps in cultural competence
Nursing education historically did not adequately address the distinctive health-care needs of Black patients or prepare nurses to provide culturally competent care. As a result, this deficit of cultural awareness and competence has contributed to disparities in health outcomes for Black patients, particularly in such areas as mental health care and maternal health.
Underrepresentation in nursing leadership
Black nurses remain underrepresented in leadership positions, academic settings, and policy-making bodies within the health-care system, in spite of efforts to increase diversity in the nursing profession. This blatant lack of representation continues to impact decision-making and policy development, thereby making it difficult to address issues of racial inequity in health care.
Urgent need for anti-racism and equity in nursing education
Historical racism in nursing continues to shape the education and practice of nurses today. The effects of historical racism in nursing are far-reaching and multifaceted, influencing everything from nursing education to patient care, professional opportunities, and health outcomes.
Addressing these issues demands a concerted effort, both to recognize the history of racism in nursing and to implement systemic changes in education, policy, and practice to ensure an inclusive, culturally competent, and equitable health-care system.
Only when these historical injustices are confronted can nursing become a more effective, inclusive profession that meets the needs of all patients and promotes social justice in health care.
Recommendations
The dismantling of anti-Black racism addresses issues at the levels of (a) the individual, (b) public education, (c) nursing education, and (d) systems.
Individual level
- Self-education and reflection are essential, along with continuous engagement in learning about the history of anti-Black racism. This includes the residual legacy of slavery, colonialism, and segregation.
- The active support of Black communities requires speaking out against racist behaviour and collaborating with Black-led initiatives.
- Also required is speaking out against racism in conversations and public spaces, even when this may feel uncomfortable.
- Denial of ethnic bigotry, or dismissing the impact of race on people’s experiences, particularly those of Black individuals, is to be avoided.
- Education requires the use of diverse teaching materials in the classroom, as well as authors and individuals who represent the lived experiences of Black communities.
Nursing education: anti-racist curriculum
There is an urgent need for nursing programs to actively incorporate anti-racism into their curricula and provide the tools and knowledge necessary for nurses to challenge racial biases and provide equitable care.
Dismantling anti-Black racism in nursing education is essential for promoting equity and improving health-care outcomes, in addition to fostering an inclusive and culturally competent nursing workforce. To achieve these goals, educational nursing institutions can adopt a range of strategies, including the following:
- The integration of anti-racist education into nursing curricula, including content on health disparities, structural racism in health care, and cultural competence.
- Teaching about the historical mistreatment of Black individuals in medical research, and its consequent residual impact on trust in the health-care system.
- Ensuring that nursing students are exposed to diverse populations, including Black patients in clinical settings.
- The introduction of critical race theory (CRT) as a framework for understanding how race and racism intersect with health-care delivery, and challenging students to critically examine policies and practices that perpetuate inequities. This is beneficial to both educators and students, as educators can better understand students of diverse backgrounds when they apply CRT to their practice. As well, students of those backgrounds feel seen when CRT is incorporated into learning.
Systems level: policy change
It is necessary to advocate for policies that address systemic racism across all sectors, especially health care and education.
Also required is the implementation of systems for collecting and analyzing data on racial disparities to identify patterns, especially as they relate to Blacks, so that resources can be channelled into the communities where they are most needed.
Institutional accountability
Organizations and institutions must be encouraged to establish clear, well-defined anti-racist policies, as well as accountability measures that monitor progress in eliminating racial disparities.
Further, institutions should be held accountable for their actions and commitment to diversity, equity, and inclusion (DEI) through transparency and public reporting on progress.
Community representation and engagement
Direct engagement with Black communities is required to better understand their needs and perspectives, and to ensure that any likely reform reflects the lived reality of those most affected by racism.
Conclusion
Dismantling anti-Black racism in nursing is not just an ethical obligation, but should be viewed as a crucial step towards creating a health-care system that is equitable and just. The persistent bias and discrimination that Black nurses and patients face in health-care settings are not isolated issues; they are systemic barriers that compromise the very core of nursing’s mission to provide quality care to all.
The cost of inaction is too high. We cannot afford to allow anti-Black racism to run rampant in a profession that has the power to heal and transform lives. Let us rise to the challenge and commit to dismantling anti-Black racism in nursing — not just for the benefit of Black individuals, but for the future of health care as a whole.
It is time to create a nursing workforce and health-care system in which every person, regardless of their race, can thrive and receive the care they deserve. The work begins now.
References
Canadian Human Rights Commission (2021). It’s time to step up to end racism. Ottawa: Canadian Human Rights Commission. https://www.chrc-ccdp.gc.ca/resources/newsroom/statement-its-time-step-end-racism
Flynn, K. (2011). Moving beyond borders: A history of Black Canadian and Caribbean women in the diaspora. Toronto: University of Toronto Press.
Jefferies, K. (2020). The strong Black woman: Insights and implications for nursing. Journal of the American Psychiatric Nursing Association, July–August, 28(4): 332–338.
McCullough, S., & McRae, M. (2018). The story of Black slavery in Canadian history. Winnipeg: Canadian Museum for Human Rights.
McPherson, K. (2003). Bedside matters: The transformation of Canadian nursing, 1900–1990. Toronto: University of Toronto Press.
Yvonne Sam is a retired head nurse, secondary school teacher, examiner for the Ordre des infirmières et infirmiers du Québec, and author of Behind the Scenes in Nursing: A Nurse’s Reflection on the Challenges and Triumphs within the Healthcare System.
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